When a Pandemic Begins, a Mental Health Crisis Threatens to Follow

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The psychological implications of a pandemic also impinge on the social fabric. Photo: Taras Chernus/Unsplash.

Brock Chisholm, the first director-general of the WHO, was a psychiatrist who famously said, “Without mental health, there can be no true physical health.” His words exemplify the idea – and now truism, after years of research – that mental and physical health are fundamentally and inextricably linked.

While it’s almost impossible to consume any news today without encountering a glut of information, and misinformation, about COVID-19, there isn’t nearly enough about the mental health aspects of the ongoing pandemic. This is surprising given how scientists have noted that, historically, infectious disease outbreaks have been accompanied by a widespread rise in anxiety and fear among the general populace. The unfamiliar, unpredictable nature of a new disease together with its invisible nature make it a potent source of worry.

During the SARS outbreak in 2003, researchers documented several comorbid mental health concerns along with the illness, including symptoms of depression, anxiety and psychosis, and panic attacks. There are many possible reasons for this. People affected with and being treated for SARS likely faced social isolation as well, prompted by their having been quarantined; their illness may have also been stigmatised and have found themselves discriminated against as a result. It’s also possible that people who had SARS harboured feelings of guilt for ‘contaminating’ others, so to speak.

These are important factors to consider when trying to understand the lived experiences of those currently affected with COVID-19, and to shape public health responses that also address their mental health concerns.

It’s clear that infectious diseases have a powerful psychological impact on all people, including those not affected by the virus. Our response to these illnesses is not only guided by medical knowledge and information but also by the social meaning we ascribe to them.

In the internet age, most of the information we consume is online – a behavioural change that has radically altered the way people communicate about health issues. For example, one study analysing the public response to the Ebola and swine flu outbreaks on Twitter found that users expressed intense fear about both illnesses. Several articles in the news and social media posts tended to sensationalise the outbreak and spread misinformation, contributing to panic. While these reactions were considered proportionate to the immediate situation during the outbreak itself, interpreted as means to spread awareness, the study also found that social media engagement tended to ‘fan the flames’ of fear and anxiety amidst people.

This is perhaps why several accredited health organisations, including the WHO, have recommended that people seek news and advice from trusted health professionals and avoid rumours and potential misinformation that could cause distress and discomfort.

That said, even legitimate information is not always good. People with pre-existing anxiety-related concerns are already struggling with their mental health without having to deal with a tsunami of do’s and don’ts, not all implications of which have been thought out. Persons with compulsive hand-washing habits could be threatened by public service messages encouraging people to wash their hands as often as possible, potentially exacerbating their mental illness. Those with post-traumatic stress disorder and other anxieties specific to health and contracting illnesses may also suffer from panic attacks and exhibit heightened stress responses.

Apart from the psychological consequences of a health crisis, there is also an interesting psycho-economic impact that shows in our consumerist instincts, as we wish to hoard disinfectants, face masks, toilet rolls and food. These instincts are fuelled not only by media reports of shortages but also by a fundamental need to stay in control of our lives. The risk on the flip side is that such behaviour could actually distract us from more important safety measures like hand-washing or closely following quarantine instructions.

Hoarding also indicates that people still believe – erroneously – health is a personal matter. However, one’s community as a whole needs to be able to access these products to maintain hygiene. Accessible and universal healthcare is imperative to maintain public health.

The psychological implications of a pandemic also impinge on the social fabric. For example, according to the sociologist Stanley Cohen, at a time of moral panic, “A condition, episode, person or group of persons emerges to become defined as a threat to societal values and interests.” In the 1980s, for example, the public reaction to the emerging awareness of an HIV/AIDS pandemic included many people in many countries targeting and abusing gay men, who were seen to be responsible for transmitting the virus.

Similarly, blame for the spread of COVID-19 has been pinned in many quarters on one particular community – of the people of Hubei province, where the causative virus originated in November 2019 – deemed to be responsible because of their ‘deviant’ behaviours and cultural practices. A reinforcement of preexisting racial prejudice has also contributed to several instances of overt discrimination, such as verbal and physical attacks on persons of Chinese descent, around the world. Right-wing politicians in the US and Europe have also used this rhetoric to call for tightening of immigration laws and to further prejudices against asylum-seekers.

Closer home, students hailing from India’s northeast who were studying in Mumbai have complained that they were filmed without their consent and that the perpetrators had circulated the video to raise ‘awareness’ about a ‘carrier’ of the virus on campus.

Finally, it is important to recognise that during a pandemic – or for that matter during any public emergency – people already on society’s margins are affected more than others closer to the centre. Both the mainstream and the social media are replete with requests for people to stay at and work from home to avoid contracting and transmitting the virus – but this isn’t very feasible for members of marginalised castes and/or classes who engage in manual labour and earn a daily wage.

The politics of access are at play even in the education sector: not all families can access and/or use the technology that will allow their children to study remotely. The ability to carry on all tasks at home is also a privilege, a privilege that privileges productivity at the cost of paying attention to one’s mental health.

It’s clear that mental and physical health operate as much in tandem as mental and physical ill-health. Government policy and healthcare systems need to take this into consideration when framing a response to the COVID-19 pandemic.

Farah Maneckshaw is studying applied psychology (clinical) at the Tata Institute of Social Sciences, Mumbai.